多囊卵巢综合征患者控制性超促排卵过程AMH和INHB浓度变化的临床研究

Changes of anti-Mullerian hormone( AMH ) and inhibin B( INHB ) during controlled ovarian hyperstimulation in polycystic ovarian syndrome

目的探讨多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者控制性超促排卵(controlled ovarian hyperstimulation,COH)过程中血清抗苗勒管激素(anti-Müllerian hormone,AMH)和抑制素B(inhibin B,INHB)浓度的变化及其对COH结局的预测价值。方法 PCOS组患者37例,对照组患者41例。检测患者月经周期第2/3天(D2/3)、促性腺激素(gonadotrophin,Gn)刺激第5天(D5)、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)日(D-hCG)血清AMH及INHB浓度及取卵日卵泡液中AMH及INHB浓度,观察其动态变化及其对COH结局的影响。结果在COH过程中,血清AMH浓度逐渐降低,而血清INHB浓度逐渐升高。PCOS组患者hCG日血清雌二醇(estrodiol,E2)浓度、获卵数、冷冻胚胎数较对照组明显升高(P<0.05,P<0.001),而Gn用量、受精率均低于对照组,差异有统计学意义(P<0.05),2组患者的临床妊娠率比较,差异无统计学意义(P>0.05)。血清AMH和INHB浓度与Gn剂量、hCG日E2浓度具有相关性(P<0.05,P<0.001),但是与获卵数、临床妊娠率无相关性(P>0.05)。结论 PCOS患者AMH和INHB浓度在COH过程中呈现动态变化,可以预测COH中卵巢的反应性,但是对超促排卵结局的预测价值还有待进一步研究。

Objective To explore dynamics of anti-Mullerian hormone （ AMH ） and inhibin B （ INHB ） during controlled ovarian hyperstimulation （ COH） in polycystic ovarian syndrome （ PCOS ） , and assess the value of these dynamic changes on the prediction of outcome in PCOS patients undergoing in vitro fertilization （ IVF） .Methods Thirty-seven women with PCOS and 41 women with normal ovarian reserve as the control were recruited in the study .AMH and INHB levels were measured in serum on menstrual cycle day 2 or 3 （D2/3）, day 5 of gonadotropin stimulation（D5）, human chorionic gonadotropin（hCG） day （D-hCG） and follicular fluid（FF） on oocyte retrieval day during IVF treatment , and the relationship of AMH and INHB levels with COH outcomes was analyzed .Rseults （1） AMH levels gradually decreased while INHB levels gradually increased from D 2/3to D-hCG during COH procedure .（2） Significant differences were observed in estradiol（E2） levels of hCG day, gonadotrophin（Gn） dosage, retrieved oocytes, fertilization rate and frozen embryos （P〈0.05） in PCOS and control groups.（3） There was a negative correlation in serum AMH and INHB levels on D 2/3, D5 and D-hCG with Gn dosage, positive correlation with estradiol of hCG day （P〈0.05, P〈0.001）, no correlation with oocytes retrieval and clinical pregnancy rate（P〉0.05）.Conclusion Serum AMH and INHB levels are demonstrated to have dynamic changes during COH procedure in PCOS patients , and reflect the ovarian response in COH .The predictive value of AMH and INHB on COH outcomes in PCOS remains to be evaluated via further research .